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October 23, 2007

Complications

Question from Princeton Junction, New Jersey, USA

My 18-year-old son was diagnosed with type 1 almost two years ago and his A1cs have ranged from 5.7% to 5.0%. The last few readings were 5.2 to 5.4%. He uses an insulin pump. I have read on your site that if nephropathy has not started within 10 to 15 years after diagnosis, it is unlikely that it will rear its ugly head and that the person is pretty much protected from nephropathy. If my son can continue his excellent control, is he still at risk for diabetic nephropathy? Doesn't excellent control protect him from nephropathy and other complications? The endocrinologist I see one for my thyroid problem has told me that the incidence of retinopathy and nephropathy has been going down and isn't as big a threat anymore as heart attacks and strokes. Do you agree?

ANSWER:

Overall glucose control (and A1c levels that measure such control) are all highly correlated with diabetes complications. But, there are other factors such as family health issues, genetics, environment, smoking, and lipids that also are important. How susceptible one particular person is to high sugar damage is also probably extremely important, but difficult to measure and assess. Everything that you wrote and asked about is true but does not help much for an individual person. Glucose variability and swings on a day to day level are probably also important as well. The tighter the control - without recurrent or severe hypoglycemia - the better the short and long term effects on eyes, kidneys, blood pressure, brain function, heart, general circulation, growth, etc. SB